The adverse consequences of premature diagnosis

I have spent 3 days at the Society to Improve Diagnosis in Medicine.  Whenever I come to this meeting, I have insights from listening to talks and many conversations with leaders in the field. When one considers diagnostic errors, one must consider two important factors – physician factors and system factors.  We have a major system factor that can cause problems.  Most hospitals in the US require a diagnosis for admission.  I believe this rule increases diagnostic errors. Currently I am developing a talk based on the lessons we can learn from fictional detectives.  One example that I will likely use came from a relatively minor TV show – the Glades.  In one episode, the detective is walking around the crime scene making observations.  Someone comes to him and asks what he thinks happened.  He turns and tells the person that he is still collecting data and does not have enough to develop a hypothesis (or something like that). Patients get admitted, either from the emergency department or from an outpatient office because the patient is clearly not well.  But too often the admitting physician really does not have enough data to make a correct diagnosis.  When the system requires an admitting diagnosis, they give a best guess diagnosis. But how can we get a best guess with incomplete information?  When the patient comes to the receiving physician (often a hospitalist), the patient already has a diagnostic label. This sequence, which occurs every day in mo...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs